Virginia - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Virginia Department of Behavioral Health and Developmental Services (DBHDS) licenses providers of Developmental Disabilities (DD) Waiver services, which encompass the Building Independence (BI), Family and Individual Supports (FIS), and Community Living (CL) waivers. These waivers fund a continuum of care ranging from in-home supports and day habilitation to sponsored residential and group home living.

Applicants face a mandatory application waitlist upon submitting their initial paperwork through the DBHDS CONNECT Provider Portal. Before a license is granted and Medicaid enrollment is permitted, prospective providers must secure preliminary application approval, affiliate with a Local Human Rights Committee (LHRC), and have their Human Rights Policies and Procedures formally approved by the LHRC.

1. Service Definition and Scope

Virginia's DD Waivers provide home and community-based services (HCBS) to individuals with intellectual and developmental disabilities. The service array is divided across three specific waivers: Building Independence (BI), Family and Individual Supports (FIS), and Community Living (CL).

Services range from intermittent supports like workplace assistance and community coaching to 24/7 residential models such as group homes and sponsored residential services. Providers must be specifically licensed for the distinct service models they intend to offer.

• Building Independence (BI) Waiver: Supports adults living independently in the community.
• Family and Individual Supports (FIS) Waiver: Provides supports for individuals living with their families or in their own homes.
• Community Living (CL) Waiver: Covers 24/7 residential services and supports for individuals with complex needs.
• Service Authorization: DBHDS is the designated agency tasked with approving all Service Authorization (SA) requests for the DD Waivers.

2. Regulatory and Oversight Agencies

Two primary state agencies govern DD Waiver services in Virginia. DBHDS handles licensure, service authorization, and quality monitoring, while the Department of Medical Assistance Services (DMAS) serves as the state Medicaid agency responsible for provider enrollment and claims payment.

Providers must interact with multiple divisions within DBHDS, including the Office of Licensing and the Office of Provider Network Supports, to maintain compliance and access training.

• DBHDS Office of Licensing: Issues provider licenses and conducts inspections (https://dbhds.virginia.gov/licensing-information-for-providers).
• DBHDS Office of Provider Network Supports: Manages provider development and training (https://dbhds.virginia.gov/developmental-services/provider-network-supports).
• Department of Medical Assistance Services (DMAS): Oversees Medicaid enrollment and funding (https://www.dmas.virginia.gov).
• DMAS Medicaid Enterprise System (MES): The portal for Medicaid provider enrollment and claims (https://vamedicaid.dmas.virginia.gov/provider).

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia does not utilize a Certificate of Need (CON) process for DD Waiver HCBS, nor does it restrict enrollment to closed networks. However, DBHDS enforces strict structural prerequisites before an application can proceed to full review.

The most prominent structural precondition is the DBHDS application waitlist; once an initial application is submitted in the CONNECT portal, it is placed on a waitlist pending review capacity. Additionally, applicants must secure affiliation with a Local Human Rights Committee (LHRC) before licensure.

• Application Waitlist: New applications submitted to the DBHDS CONNECT Provider Portal are placed on a waitlist until licensing specialists are available to process them.
• LHRC Affiliation: Applicants must affiliate with a Local Human Rights Committee (LHRC) and have their Human Rights Policies approved.
• Background Check Account: Applicants must set up an account to request criminal history and central registry background investigations for identified staff.
• HCBS Self-Assessment: After receiving a license, providers must complete the HCBS Provider Self-Assessment to ensure compliance with the CMS Final Rule.

4. Licensure and Certification Requirements

Providers must obtain a license from the DBHDS Office of Licensing under the regulations found at 12VAC35-105. The entire application process is managed digitally through the DBHDS CONNECT Provider Portal.

The process requires the submission of comprehensive policies, procedures, and forms, followed by a demonstration of knowledge regarding these required documents during the review phase.

• Application Portal: All new applications and modifications must be submitted through the DBHDS CONNECT Provider Portal.
• Regulatory Citation: Providers are licensed under 12VAC35-105 (Rules and Regulations for Licensing Providers by DBHDS).
• Policy Approval: Applicants must submit and receive approval of required licensing policies, procedures, and forms.
• Human Rights Policies: Must be submitted, reviewed, and approved by the affiliated LHRC.

5. Medicaid Provider Enrollment

Once licensed by DBHDS, providers must enroll with Virginia Medicaid through the DMAS Medicaid Enterprise System (MES). Providers must sign a Participation Agreement applicable to their specific provider type.

All providers undergo a federally mandated comprehensive screening based on categorical risk levels (limited, moderate, or high) and must revalidate their enrollment at least every five years.

• Enrollment Portal: Applications are processed through the DMAS MES Provider Resources site.
• NPI Requirement: A National Provider Identifier (NPI) must be obtained from NPPES and provided with the application.
• Application Fee: Institutional providers may be required to pay a federally-determined application fee at enrollment or revalidation.
• Screening Risk Levels: Providers are screened at limited, moderate, or high risk levels, which may include federal and state database checks.

6. Staffing, Training and Background Checks

Virginia mandates specific training competencies for Direct Support Professionals (DSPs) and supervisors working in DD Waiver programs. DBHDS centralizes many of these requirements through the Commonwealth of Virginia Learning Center (COVLC).

Comprehensive criminal history and central registry background investigations are required for all identified staff prior to employment.

• DSP Orientation: Information on DSP and Supervisor Orientation Training and Competencies is required and found on the DBHDS website.
• Medication Management: Required for DSPs authorized to administer medication in DBHDS licensed programs.
• Background Investigations: Providers must request criminal history and central registry checks as required by Virginia Code § 37.2-416.
• Emergency Training: The Office of Licensing requires staff training in emergency preparedness and infection control.

7. Documentation, Policies and Records

Providers must maintain extensive documentation to comply with both DBHDS licensing standards and DMAS Medicaid requirements. This includes person-centered Individual Support Plans (ISPs) and strict adherence to HCBS Settings Rule requirements.

Providers must submit evidence of follow-up and monitoring to assess ongoing progress of the ISP, ensuring services are delivered and health and safety are maintained.

• Human Rights Documentation: Approved Human Rights Policies and Procedures must be maintained and followed.
• HCBS Settings Compliance: Providers must participate in activities to assure ongoing compliance with the Final Rule Settings Requirements (42 CFR 441.301(c)(4)).
• WaMS Enrollment: All providers must be enrolled in the Waiver Management System (WaMS) before offering services.
• ISP Monitoring: Providers must document ongoing progress and delivery of services according to the Individual Support Plan.

8. Billing, Rates and Claims

DD Waiver services in Virginia are carved out of managed care and are billed directly to DMAS as fee-for-service (FFS). Providers must secure service authorization through DBHDS before billing.

Authorizations are managed in WaMS, while claims are submitted and adjudicated through the DMAS MES portal.

• Service Authorization: Managed through the DBHDS Waiver Management System (WaMS).
• Claims Submission: Billed through the DMAS Medicaid Enterprise System (MES) using the provider's NPI.
• Carve-Out Status: DD waiver services are carved out of Cardinal Care Managed Care and managed directly by DMAS.
• ORP Requirements: Ordering, referring, and prescribing providers must be enrolled in Medicaid for claims to adjudicate.

9. Approval Sequence and Timeline

The approval sequence begins with the DBHDS CONNECT portal application and placement on the waitlist. Once reviewed, providers must secure LHRC affiliation and policy approvals.

After DBHDS issues the license, the provider completes the HCBS Self-Assessment, enrolls in WaMS, and finally submits the Medicaid enrollment application through the DMAS MES.

• Step 1: Submit initial application and attachments via DBHDS CONNECT Provider Portal.
• Step 2: Waitlist placement and subsequent preliminary approval by DBHDS.
• Step 3: Affiliate with an LHRC and secure Human Rights Policy approval.
• Step 4: Receive DBHDS License and complete the HCBS Provider Self-Assessment.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete policy submissions or failure to properly affiliate with an LHRC. During the waitlist period, lack of responsiveness to DBHDS requests can result in application closure.

Post-licensure, common survey deficiencies include lapsed DSP training competencies, incomplete background checks prior to hire, and failure to document ISP progress notes accurately.

• Policy Deficiencies: Failure to submit or demonstrate knowledge of required licensing policies and procedures.
• Background Check Violations: Allowing staff to work prior to the completion and clearance of criminal history checks.
• Training Lapses: Incomplete DSP Orientation or Medication Management competencies.
• Medicaid Denial: Failing to submit requested information or pay the application fee within 30 days of notice.

11. Key Contacts and Resources

Prospective providers should utilize the DBHDS and DMAS portals for all application and enrollment activities. The DBHDS Office of Provider Network Supports offers quarterly roundtables and listserv announcements for new providers.

Technical assistance for Medicaid enrollment is handled by Gainwell Technologies on behalf of DMAS.

• DBHDS CONNECT Provider Portal: https://dbhds.virginia.gov/licensing-information-for-providers
• DMAS MES Provider Enrollment: https://vamedicaid.dmas.virginia.gov/provider
• DMAS Provider Enrollment Email: [email protected]
• DMAS Appeals Portal: https://www.dmas.virginia.gov/appeals/

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